Boy Receives First Successful Bilateral Hand Transplant

Eight-year-old Zion Harvey is the first child in the world to successfully receive a bilateral hand transplant, which was performed successfully last month at The Children’s Hospital of Philadelphia (CHOP). The ten hour surgery was announced as successful by lead surgeon Dr. L. Scott Levin on Tuesday, July 28th; in the meantime, Zion is redeveloping the full range of coordination of his hands with physical therapy.

“He woke up smiling,” said Dr. L. Scott Levin, CHOP’s transplant program director, according to the Washington Post. “There hasn’t been one whimper, one tear, one complaint.”

Zion lost both his hands and feet to a bacterial infection when he was two years old, and amputation was necessary to save his life from the resulting sepsis. He re-learned how to walk with the help of prosthetics and physical therapy, but no existing prosthetics could replicate the fine motor capabilities of his hands. He adapted remarkably to his situation, and used his forearms to do everything other children can do: write, eat, and play games on his iPad. Levin describes Zion as precocious, with “a maturity that is way beyond his eight years.”

Zion was selected as a possible donor due to the pre-existing immunosuppressive drugs he takes for his transplanted kidney, donated to Zion when he was four years old by his mother, Pattie Ray. The infection he endured as a two-year-old also caused his kidneys to fail, and he underwent weekly dialysis for two years until his transplant.

Immunosuppressive medications prevent Zion’s immune system from rejecting the foreign kidney and will have a similar effect on the transplanted hands. Unfortunately, use of these medications result in a weakened immune system, meaning that Zion is at greater risk of infections and cancers. It is likely that he will have to take immunosuppressive drugs for the rest of his life.

“Seeing Zion’s new hands felt like he was being reborn,” said Ray, according to NBC News. “I see my son in the light I haven’t seen him in five years.”

Hand transplants usually last anywhere from eight to 12 hours, longer than most heart transplants. Surgeons connect the bones with steel plates and screws first, and then they align the individual tendons, arteries, and nerves. Dr. Levin successfully led a team of a dozen surgeons, eight nurses, and over three anesthesiologists—approximately 40 healthcare professionals in total—in the ten hour surgery.

“The surgical team was divided into four, simultaneous operating teams, two focused on the donor limbs, and two focused on the recipient,” read the statement released by CHOP. “Microvascular surgical techniques were used to connect the arteries and veins,” to re-establish blood flow and tissue perfusion.

In Zion’s procedure, descriptive tags were created by Dr. Scott Levin and his team, which were then attached to specific parts of the arm before being connected. The original skin was then fused with the skin of the new hand to finish the extensive procedure.

Zion’s donated hands came from an anonymous donor, and the timing was called “amazing,” by Dr. Levin. Only about 15 such donations are possible per year, and Zion had been on the waiting list since April before the hospital contacted him with the opportunity. The news was a shocking joy to Zion’s family.

The first hand transplant was performed in Ecuador in 1964, but the transplant was eventually rejected by the patient’s own immune system. Fortunately for patients today, there has been remarkable progress in the development of immunosuppressants to encourage such transplants to succeed. Many hand transplant surgeries have been performed on adults ever since, but prior to Zion, the surgeries were never performed on a child. Relatively few of these procedures have been performed; the surgeries, physical therapy, and immunosuppression drugs are expensive and have notable side-effects.

“He’s no different than the thousands of organ transplants that require medication,” Levin said about the operation, according to Huffington Post. “We monitor him very carefully for the side effects.”

The donating family remained anonymous as per their wishes and was thanked by Levin for their generosity and bravery.

“I think the difference is finding a family who has the courage to relinquish the arms of a child who just died and give hope and life and quality of life to a child who’s still living,” he said, according to the Huffington Post. The specific date of the transplant was not disclosed by the hospital.

This surgery sets a successful precedent for other children who, like Zion, just want to be able to play on the monkey bars at school or throw a football. Dr. Levin hopes that this is just the start of such procedures for children everywhere.

“I hope he’s the first of literally hundreds or thousands of patients that are going to be afforded this surgery,” he said. The Children’s Hospital stated that it would not charge Zion’s family for any costs beyond those covered by their medical insurance.